Laparoscopic approach for urgent abdominal surgery in patients with left ventricular assist devices

Livi, Ugolino; Guzzi, G.; Tursi, V.; Martínez, Blanca; Albanese, Maria; Corno, C.; Badano, Luigi P.

doi:10.2459/jcm.0b013e328329cb0f

Cited by 14 publications

(17 citation statements)

References 9 publications

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“…This can be avoided by maintaining intraabdominal pressure lower than 10-12 mm Hg. 22 Infection can also be a concern. Antibiotic prophylaxis in accordance with the usual standard for abdominal surgical procedures was used in our patients.…”

Section: Discussionmentioning

confidence: 98%

“…24 The most frequently reported complication in these patients is postoperative bleeding due the necessary anticoagulation therapy required for the VAD in order to avoid thromboembolic events. 22,25,26 Many of these patients require hospital admission prior to elective operations and conversion from warfarin to heparin anticoagulation, which can be stopped or reversed in the immediate perioperative period. In emergency procedures, such as with these two patients, transfusion of fresh frozen plasma is required to acutely correct the patient's chronic anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

“…2 To date there are 25 previously reported cases of laparoscopic surgery successfully performed on patients with VADs, with seven of these procedures being laparoscopic cholecystectomy. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] During abdominal operations, certain precautions can be taken to improve the safety of patients with VADs. The use of imaging, such as fluoroscopy, can help to identify the locations of the VAD and its associated drive wires.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Laparoscopic Cholecystectomy in Patients with HeartMate II Left Ventricular Assist Devices

Eck

Belli

Smith

et al. 2014

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Laparoscopic cholecystectomy can be performed safely on patients with ventricular assist devices. Complications due to damage to the device can be avoided with the assistance of fluoroscopy to identify the implanted abdominal portions of the ventricular assist device. Each laparoscopic procedure performed on these patients presents the surgeon with unique obstacles in which careful operative planning and intraoperative monitoring are essential.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic Cholecystectomy in Patients with HeartMate II Left Ventricular Assist Devices

Eck

Belli

Smith

et al. 2014

Journal of Laparoendoscopic & Advanced Surgical Techniques

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show abstract

“…Common anesthetic concerns include management of anticoagulation, 15,16 patient monitoring limitations inherent to minimally pulsatile blood flow, 10,17,18 modified surgical access to the operative site, 19–23 concern for intraoperative cardiovascular and cerebrovascular events, 24–26 management of intraoperative device malfunction, 6 and postoperative complications including bleeding 15,26–28 and infection. 29–34 …”

Section: Introductionmentioning

confidence: 99%

Complications, Risk Factors, and Staffing Patterns for Noncardiac Surgery in Patients with Left Ventricular Assist Devices

et al. 2017

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Background Patients with left ventricular assist devices presenting for noncardiac surgery are increasingly commonplace; however, little is known about their outcomes. Accordingly, the authors sought to determine the frequency of complications, risk factors, and staffing patterns. Methods The authors performed a retrospective study at their academic tertiary care center, investigating all adult left ventricular assist device patients undergoing noncardiac surgery from 2006 to 2015. The authors described perioperative profiles of noncardiac surgery cases, including patient, left ventricular assist device, surgical case, and anesthetic characteristics, as well as staffing by cardiac/noncardiac anesthesiologists. Through univariate and multivariable analyses, the authors studied acute kidney injury as a primary outcome; secondary outcomes included elevated serum lactate dehydrogenase suggestive of left ventricular assist device thrombosis, intraoperative bleeding complication, and intraoperative hypotension. The authors additionally studied major perioperative complications and mortality. Results Two hundred and forty-six patients underwent 702 procedures. Of 607 index cases, 110 (18%) experienced postoperative acute kidney injury, and 16 (2.6%) had elevated lactate dehydrogenase. Of cases with complete blood pressure data, 176 (27%) experienced intraoperative hypotension. Bleeding complications occurred in 45 cases (6.4%). Thirteen (5.3%) patients died within 30 days of surgery. Independent risk factors associated with acute kidney injury included major surgical procedures (adjusted odds ratio, 4.4; 95% CI, 1.1 to 17.3; P = 0.03) and cases prompting invasive arterial line monitoring (adjusted odds ratio, 3.6; 95% CI, 1.3 to 10.3; P = 0.02) or preoperative fresh frozen plasma transfusion (adjusted odds ratio, 1.7; 95% CI, 1.1 to 2.8; P = 0.02). Conclusions Intraoperative hypotension and acute kidney injury were the most common complications in left ventricular assist device patients presenting for noncardiac surgery; perioperative management remains a challenge.

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“…7 Furthermore, laparoscopic cholecystectomy has been 628679S RIXXX10.1177/1553350616628679Surgical InnovationAshfaq et al shown to be a safe procedure in critically ill cardiac patients, especially patients with MCAD. 6,[9][10][11][12] The aim of our study was to evaluate the safety and feasibility of laparoscopic surgery in patients with MCADs.…”

Section: Introductionmentioning

confidence: 99%

Safety and Feasibility of Laparoscopic Abdominal Surgery in Patients With Mechanical Circulatory Assist Devices

et al. 2016

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Objectives Increasing number of mechanical circulatory assist devices (MCADs) are being placed in heart failure patients. Morbidity from device placement is high and the outcome of patients who require noncardiac surgery after, is unclear. As laparoscopic interventions are associated with decreased morbidity, we examined the impact of such procedures in these patients. Methods A retrospective review was conducted on 302 patients who underwent MCAD placement from 2005 to 2012. All laparoscopic abdominal surgeries were included and impact on postoperative morbidity and mortality studied. Results Ten out of 16 procedures were laparoscopic with 1 conversion to open. Seven patients had a HeartMate II, 2 had Total Artificial Hearts, and 1 had CentriMag. Four patients had devices for ischemic cardiomyopathy and 6 cases were emergent. Surgeries included 6 laparoscopic cholecystectomies, 2 exploratory laparoscopies, 1 laparoscopic colostomy takedown, and 1 laparoscopic ventral hernia repair with mesh. Median age of the patients was 63 years (range, 29-79 years). Median operative time was 123 minutes (range, 30-380 minutes). Five of 10 patients were on preoperative anticoagulation with average intraoperative blood loss of 150 mL (range, 20-700 mL). There were 3 postoperative complications; acute respiratory failure, acute kidney injury and multisystem organ failure resulting in death not related to the surgical procedure. Conclusion The need for noncardiac surgery in post-MCAD patients is increasing due to limited donors and due to more durable and longer support from newer generation assist devices. While surgery should be approached with caution in this high-risk group, laparoscopic surgery appears to be a safe and successful treatment option.

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Laparoscopic approach for urgent abdominal surgery in patients with left ventricular assist devices

Cited by 14 publications

References 9 publications

Laparoscopic Cholecystectomy in Patients with HeartMate II Left Ventricular Assist Devices

Laparoscopic Cholecystectomy in Patients with HeartMate II Left Ventricular Assist Devices

Complications, Risk Factors, and Staffing Patterns for Noncardiac Surgery in Patients with Left Ventricular Assist Devices

Safety and Feasibility of Laparoscopic Abdominal Surgery in Patients With Mechanical Circulatory Assist Devices

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